An International, Multicenter, Retrospective Study of Nosocomial Pneumonia due to Pseudomonas aeruginosa
Nosocomial pneumonia is a prevalent hospital-acquired infection associated with increased morbidity and mortality. The purpose of this study is to describe the clinical characteristics, antibiotic resistance patterns, and outcomes of patients with Pseudomonas aeruginosa nosocomial pneumonia.
Methods: Retrospective, hospital-based medical record abstraction. Records were obtained from 10 hospitals throughout the United States and Europe.
Results: Among the 396 patients included in the study, ventilator-associated (50%) was the most common classification followed by hospital-acquired (26%), and healthcare-associated pneumonia (24%). Concomitant bacteremia occurred in 23% of cases and septic shock complicating pneumonia occurred in 63% of patients. Antibiotic resistance was common across all drug classes: aminoglycosides (27%), antipseudomonal (AP) penicillins + β-lactamase inhibitors (29%), AP carbapenems (36%), AP cephalosporins (26%), and ciprofloxacin (34%). Multidrug resistance (MDR) was present in 31% of pneumonia cases. Appropriate initial antibiotic therapy was prescribed in 60% of patients. In-hospital mortality occurred in 42% of patients. In-hospital mortality was significantly greater in patients with an MDR isolate compared to non-MDR isolates (51% v. 33%, p = 0.001). The median (IQR) time-to-death was 12 (4, 25) days. Median (IQR) hospital length of stay was 30 (17, 56) days and was significantly longer in survivors compared to nonsurvivors (median 36 v. 27 days, p = 0.02).
Pseudomonas aeruginosa nosocomial pneumonia is frequently complicated by septic shock and has high in-hospital mortality rate. Antibiotics resistance is common and likely contributes to an unacceptably low rate of initial appropriate antibiotic therapy.
Cubist Pharmaceuticals: Grant Investigator, Research grant
Crucell/Janssen/J&J: Consultant, Consulting fee
C. Chen, None
J. Rello, Cubist: Grant Investigator, Research grant
J. E. Chastre, Cubist: Grant Investigator, Research grant
V. Menon, None
M. Kollef, Tetraphase: Grant Investigator, Research support
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